Abstract
Introduction:
Transversus abdominis plane (TAP) blocks are routinely integrated into enhanced recovery protocols. Our pilot aimed to understand institutional TAP block practices, increase utilization, and evaluate postoperative narcotic use and length of stay (LOS) among metabolic and bariatric surgery (MBS) patients.
Methods:
An enhanced recovery protocol was implemented in May 2020 at a single academic center; retrospective review evaluated MBS patients (October 2019–February 2021) with no TAP block, anesthesiology-administered (ANES) TAP blocks, or surgery-administered (SURG) TAP blocks.
Results:
Overall, 313 patients received no TAP (n = 135), ANES TAP (n = 32), or SURG TAP (n = 146). After pilot initiation, average monthly TAP block administration increased from 34% to 75%. Further provider practice review revealed the average SURG block formulation was denser than the average ANES block along with increased usage of dexamethasone. Postoperative acetaminophen and gabapentin were ordered more frequently in the ANES group, whereas ketorolac was more frequently ordered in the SURG group. TAP block patients had significantly reduced total postoperative opioid use and LOS versus patients with no TAP blocks.
Conclusions:
Previously unknown variation within TAP block practices was identified, allowing for improved understanding and ability to address operational challenges for improvements. Next steps include standardization of TAP block administration and larger data collection efforts.
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